Healthcare Provider Details

I. General information

NPI: 1679434674
Provider Name (Legal Business Name): ANUSHA SHELANEE FERNANDO PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2025
Last Update Date: 11/19/2025
Certification Date: 11/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 CHARLEVILLE BLVD
BEVERLY HILLS CA
90211-2805
US

IV. Provider business mailing address

8701 CHARLEVILLE BLVD
BEVERLY HILLS CA
90211-2805
US

V. Phone/Fax

Practice location:
  • Phone: 310-551-5100
  • Fax:
Mailing address:
  • Phone: 310-551-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number210252276
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: